Sunday, 23 July 2017

RadioTimes had a handy thing for keeping an eye on when favourite films or programmes were going to be broadcast. As long as you had an account you could click a 'Watchlist' button on the page for any programme, then you could look at your watchlist to see what was coming up in the schedules.

I'm not quite sure how I discovered this but I associate it with coming across films that David Arnold had scored and tweeting him that they were on. Gradually I added more of his films and would let him know - whether or not he wanted me to - that a particular film of his was to be screened. Sometimes he'd retweet the info and on occasion people would write back saying how much they loved that score, which was always rather lovely to be included in. It was also fun when he'd live tweet stuff about the making of the film or the score.

More important news RT @JoBrodie: Tomorrow Never Dies is on ITV2 8pm this evening (Friday 19th), and Hot Fuzz is on ITV later at 10.40pm.

But RadioTimes are stopping the Watchlist, and now we have to use some app instead. Alas I can't download any more apps onto my very full phone so I'm looking for a 'web-based solution'. Do you know of any?

NHS England is updating its guidance to Clinical Commissioning Groups (CCGs), recommending that certain items offered in primary care should no longer be prescribed. This includes homeopathy but some herbal remedies are in there too, also glucosamine + chondroitin used (ineffectively as it turns out) for osteoarthritis pain.

A. Things I want to consider in this post, the short version1. Has homeopathy been banned from the NHS?
No, not yet

2. Is it likely that homeopathy will be removed from the NHS?
Seems pretty likely3. Homeopathy costs a fraction of the total NHS costs, why do skeptics want it removed?
The evidence isn't good, also to minimise any unwarranted positive associations with healthcare4. Are there any reasons to keep homeopathy on the NHS?
Slightly dishonest ones5. What's been the role of skeptics in removing homeopathy from the NHS?
Probably helped

B. Things I want to consider in this post, the longer version1. Has homeopathy been banned from the NHS?
Not yet. The document acknowledges that the evidence for homeopathy is poor and that homeopathy should not be prescribed, however this is a consultation document not an edict. Also this will affect England, not the whole UK.

2. Is it likely that homeopathy will be removed from the NHS?
I think so - it's widely acknowledged that it's a waste of money and there is little support for it being on the NHS. To be fair homeopathy has been declining on the NHS for two decades as this bar chart from the Nightingale Collaboration. This is more tidying up loose ends than a big new thing.

3. Homeopathy costs a fraction of the total NHS costs, why do skeptics want it removed?
While it's true that the homeopathy spend is now under £100,000 (a drop in the ocean compared with total NHS costs) it's not just about costs. We don't want money wasted on unevidenced treatments (this includes pharma drugs too), even if it is only a small amount of money. But there's also the 'halo effect': homeopathy benefits by its association with healthcare, the NHS is effectively giving its backing to nonsense. Removing it from the NHS removes this positive association. Annoyingly homeopathy also benefits from the fact that you can buy it in many highstreet pharmacists but that's a different argument.

Booting #homeopathy off NHS not *just* abt saving relatively small pot of cash, but also removes 'imprimatur' of a +ve assoc w 'healthcare'.

4. Are there any reasons to keep homeopathy on the NHS?
Not good ones, no. Some doctors have argued that patients who are distressed about perceived ill-health, despite not actually being unwell, might benefit from homeopathy or placebo pills.

The idea would involve doctors knowingly (or perhaps even unwittingly) giving patients inert medication with the aim of making them feel better (placebo effects, being taken seriously etc) without causing any side-effects. Another possible benefit is keeping a link with a patient who might otherwise withdraw from appropriate healthcare and explore unhelpful and costly options from quacks.

To be honest I do have some sympathy with this notion. The dishonesty troubles me - it's basically lying to a patient 'for their own good' but I can see examples of where I might go along with this (which also troubles me!).

Here a GP writes about 'heartsink' patients (where your heart sinks as what's ailing them isn't clear, nor is the solution) in an article on the Faculty of Homeopaths website. The FoH is a society of medical doctors who are also homeopaths.

"Another group of patients for which homeopathy can be helpful is those who frequently appear in GPs’ surgeries presenting with a whole host of “functional disorders”. Despite undergoing the full gamut of blood and hospital tests, no abnormality in the body is found. Nevertheless, these “heart sink” patients are clearly suffering from pain and discomfort, which is blighting their lives. This is understandably frustrating for them, for they know full well something is awry but there is no medical evidence for this.

Sometimes conventional medicines can be useful, but once again they are symptomatic treatments which may also produce unpleasant side-effects, resulting in the patient feeling even worse. Homeopathy affords me another approach in trying to help these patients. It doesn’t work for them all, but I’m frequently surprised at how many it does help."
Source: https://facultyofhomeopathy.org/homeopathy-general-practice-2/

5. What's been the role of skeptics in removing homeopathy from the NHS?The term 'Skeptics' is generally assumed to mean activist bloggers but obviously includes people who aren't bloggers but who are also skeptical of homeopathy - including scientists, doctors and other healthcare professionals, teachers, people who've tried it but experienced no real benefit from homeopathy, members of the public, anyone.

It's difficult to prove causality. My perception is that online skeptical activism, particularly targeted at homeopathy, really got going in the early-mid 2000s, coalescing around Ben Goldacre's Bad Science colummn and blog. Obviously scientists and doctors have obviously been skeptical of homeopathy pretty much since it was invented. Prof David Colquhoun has been blogging about homeopathy since the very early 2000s and published (in a journal) a re-analysis of some homeopathy data in a paper in 1990 - I'm sure others have too, it's just we happened to have a conversation about this recently!

The focus of skeptic activism can be both narrow and targeted (for example getting something changed, eg getting an advert taken down, getting an event moved from an academic setting etc) or wider (eg contributing to people's awareness of what homeopathy actually is) and I think both feed into each other. I think of the former as 'meat' and the latter as 'marinade' and I think skeptic activism has done both very well. It seems as if articles in the press about homeopathy are much more critical and less credulous than they have been in the past - I don't know if this can be attributed to skeptics but I know that quite a few of us have contacted journalists to point to better information.

In late 2009 the UK Government announced that it was seeking examples of topics in which a science Select Committee could "assess the Government’s use of evidence in policy-making", inviting the public to suggest topics. Homeopathy was one of many, and was chosen to be the second 'evidence check' resulting in a 2010 document recommending that funding be withdrawn.

Tuesday, 18 July 2017

These two phrases, passed on from father to daughter (I've no idea where Dad got them from) have been occasionally useful and I thought I'd share them in case others want to adopt them too.

1. To what fault in yourself do you attribute that?
I'm not sure I can really carry this one off as well as my dad (though he annoyingly remains dead when he was alive he was 6ft 2, large, loud and commanding) so I tend to use it more in jest but I leave it to you to decide how to use it :)

Dad probably used it most with jobsworth types. Or people lacking in insight.2. Well to be fair they're probably not as well-advised as me
This one's good for rebuffing annoying people who tell you that 'everyone is doing X', particularly if they're trying to sell you something or beat you in a game of I Remain Unconvinced. It's not an actual game but I tend to gamify efforts to sell me things.

Here's a bonus one from my mum...

3. X permanently has his/her foot in the stirrup of his/her high-horse
Funnily enough it's quite possible Mum might have been talking about Dad or me. She used to ring me occasionally with news of Dad's victories against companies that had foolishly tried to rip him off; he was never happier than when a proper fight was in the offing. Honestly my dad used to have the most amazingly protracted arguments (and the weird thing was they were nearly always really amiable) with companies about something failing to turn up, the wrong thing turning up, something needing replaced etc. An awful lot of Mum's, or his, stories seemed to be about vacuum cleaners - our house was like some sort of graveyard for them, a lot went there to die. Companies kept sending them, particularly after they'd spoken to my dad for upwards of half an hour.

On three separate occasions in three separate mini supermarkets in London I've mentioned to the person serving me that the high pitched, intermittent "pink" chirruping beep was their smoke detector's battery announcing its demise. Two of the people looked at me blankly (one couldn't even pick it out from the surrounding noise) and the third person told me it always made that sound and that it was the sound of a normally-functioning fire alarm - I mean really! I think next time I might be a bit more persistent.

I'm sure different kinds of smoke alarms emit different kinds of sonic death announcements but here's the one I'm most familiar with. Wouldn't it be great if the British Standards document for smoke alarm beeps kept them the same. Perhaps it does. I hope everyone knows what a failing smoke detector sounds like, it's basically an important warning. I hope everyone has a smoke detector...

Whenever I've changed the battery on a detector it's always made a
terrific din and beeps for a bit before settling down, perhaps those
beeps are to cue me in to what it sounds like - it worked for me but not
the people in the shops.

My mum once rang me when Dad was away asking if I knew what had started beeping overnight and disturbing her sleep. I think she may have ended up holding the phone near to where the sound was coming from (she didn't know it was the smoke alarm and wasn't sure of the source's exact location) and eventually we worked out what it was and she was able to change the battery.

------

I've just taken the bus home from Westcombe Park station and waited for
the 108 bus going upwards back to the heath. While standing at Bus Stop B I heard the unmistakeable sound, coming from the
houses behind me, of a failing smoke alarm. The lights were off and it
was late (and no fire!) so I didn't start knocking on doors but I hope someone works
out what the problem is.

Westcombe Park station is a lot less welcoming than Blackheath station, particularly as two
of the street lights are out - not great when it's quite a steep hill
and uneven pavement, anyway...

Perhaps
I shouldn't take the bait but when someone is wrong on the internet
(and wrong with such enthusiastic regularity) it's difficult to ignore.
If homeopaths restricted themselves to saying something along the lines
of "you might feel a bit cheerier after talking to one of us, we're mostly quite nice, but the pills are just a distraction"
I'd probably tolerate* homeopathy on the NHS, as an inert placebo. It's
the fact that homeopaths promote it as a separate system of medicine
that grates, and that some of them promote it as an alternative to real
medicine for real diseases that worries.

The homeopathy
enthusiast BrownBagPantry has posted the above quote numerous times on
her Twitter feed under the #homeopathy hashtag and I thought I'd write
up a quick rebuttal and correction of the points within it.

*It's still lying to patients in a rather paternalistic way, but that's an argument for a different post.

"Realistically, the anti homeopathy activists have a minuscule sphere of influence worldwide."
-
'Anti homeopathy activists' probably refers only to skeptical bloggers
but it's important to remember that healthcare professionals,
journalists, authors, scientists and all sorts of other people have
taken steps to warn the public about the dangers of relying on
homeopathy and other fake medicines. Many of them wouldn't recognise
themselves as 'anti homeopathy activists' though.

The 'sphere of influence' bit is perfectly true of course. We don't particularly need to influence everyone who might consider buying or using homeopathy, we only really need
to influence the decision-makers, that is people who regulate it (allow
it on to the market, or how it can be marketed) and the people who
commission it on the NHS etc. As it happens I'm also a fan of
encouraging users of homeopathy to be aware of what it is (and it looks
like plenty of people might be mistaken in thinking that it's the same
as 'herbal').

I think of the first part (influencing decision-makers) as the meat of what skeptic activists might do and the second part (public) as the background marinade
that also needs to be changed. It feels like public attitudes to
homeopathy are changing - there are more negative articles about it in
tabloid newspapers that, until recently, tended to be more supportive.
There have also been a number of high profile stories. However I don't
know how much this changes the minds of staunch supporters.

Generally
"anti-homeopathy activists" act locally - I don't write to universities
in India asking them to move a homeopathy event on their campus but I
do in the UK (with a recent success in Birmingham). However we know that
people IN Australia tackle local Australian quackery and likewise in
other countries. So the 'worldwide' thing is a bit of a red herring.
We're everywhere, having local effects, so while none of us has
worldwide influence the effect of skeptical activity is felt globally.

"Since
Hahnmann's time, these activists' opinions have been unable to stop the
manufacture & distribution of homeopathic remedies"
- I don't think we've ever tried to stop
the manufacture or distribution. Personally I've no objection to
homeopathy products being on sale (this would be like objecting to sugar
being on sale), only to the confusing or misleading advice given about
what the products can do. There have been isolated examples of products
being removed from sale because they no longer have a market license and
I think the FDA sanctioned one manufacturer for poor manufacturing
practices, but this hasn't particularly been a focus.

Recently
homeopathic teething products for babies were withdrawn from sale after
links to serious ill-health problems, combined with the discovery that
the contents of the products were not as described on the label and had
been inconsistently produced. It was the parents of the children harmed
by homeopathy that brought the action - I don't know if they consider
themselves to be anti homeopathy activists, but the manufacture and
distribution of some homeopathic remedies has most certainly happened.

"the
private practice & licensing of homeopaths; the schools,
universities, organizations and private groups that teach it;"
-
well this just isn't true. A number of universities have stopped
teaching homeopathy, most recently in Spain, and they're also stopping
validating others' courses. Hooray! The evidence base for homeopathy
(poor) is also critiqued in UK pharmacy and medical degree courses, and
there are critical-thinking modules available for schools that use it as
an example.

"the privately and government funded research studies"
-
goodness me, if people are still wasting money on research into
homeopathy when it's been comprehensively shown that any effects can be
explained by placebo then we need to step up our efforts here ;)

"surveys; the publication of books, journals and magazines for public and student consumption"
-
I don't think we've tried that much to be honest. A few people have
taken one magazine's advertisers to task for misleading content and to
get it removed from a number of shops, but no attempt's been made to
stop it from publishing. There have been a few examples of looking at
getting books removed from sale (not from being published though)
including a pharmaceutical society in the UK that still makes them
available for pharmacists (!).

"the social media
sites that educate curious health care consumers about it, and the
cured patients who sing its praises to family members, co-workers,
[casual] and longtime friends."
- particularly for Twitter
those promoting homeopathy will certainly be met with rejoinders from
people who are skeptical of the claims. I've been in work situations
where someone has suggested homeopathy and I've certainly taken the time
to explain why that might be unwise (I often gave talks to colleagues
and members of the public about diabetes research and often talked about
the risks of using either herbal or homeopathic remedies).

"The
National Center for Homeopathy in the U.S. recently noted that the
interest in their website grew by a "whopping 600%" over the past two
years."
I emailed and asked them about this and they were
unable to confirm, only wanting to know why I wanted to know, which is a
bit odd. 600% seems quite an impressive figure so you might imagine
they'd want to tell a homeopathy skeptic about it. They said it was
something that had been sent in a newsletter to members. I've no idea
then if the 600% figure is true but let's assume that it is. But it
doesn't tell us if they had only 2 visitors two years ago and that this
has just gone up to 14 visitors two years later ;) It also doesn't tell us if they're measuring all visitors (which includes Google indexing 'bots') plus people visiting by accident, or who are skeptics. Nor does it tell us what those visitors think about the information they found there.

Friday, 14 July 2017

tl;dr version: I stuffed up a computer by mucking about with the regedit or .bat file and it wouldn't start. This was in the early 90s and the only way the company could help was by faxing me instructions to type into a new text file to save on a floppy disk from which I could then boot up. Fortunately it worked :)

In the early 1990s I used a computer system which controlled a chromatography pump*, for science.

At some point something went a bit wrong with the system and my boss suggested that I be a bit braver than I had been about fixing it myself so I read the manual and asked people in the computer department. I learned that I had to do something to the registry file, which underpinned the whole functioning. So I did.

After I'd done what I thought I was supposed to do the computer wouldn't switch on (well it wouldn't boot up and I couldn't interact with it), so I was now in a worse position. By now my boss agreed with me that I probably should have called in an expert and I was a bit worried that I'd seriously stuffed up the computer and rang the manufacturer to ask for help.

The company said that I'd need to boot the computer from a disk (which I didn't have) so they said they'd fax me a set of instructions - I don't think they had email at that time, though I'm fairly sure that I did (was working in a university), so a fax it was. The fax turned up and the program was pretty short - I went to another computer, opened up a .txt file in notepad, typed in the code and saved it with the appropriate file ending onto a floppy disk, put it in the moribund computer and switched it on. It worked perfectly ;)

I am just recording this small curiosity in the history of me killing computers...

*The pump gently delivered a stream of solvent, at a defined rate,
through a long thin chromatography column which I used to separate
components in my samples, for lipid chemistry purposes. The column
contained a substance that slowed down - at different rates - all of the
components in my samples as they passed through. This meant they came
out the other end ('eluted') at different times and the amount of them
could be measured individually. The separation was based on a relative
attraction to either the solvent or the column's retarding material
(also a little bit based on their size and other physico-chemical
properties). This resulted in a complex mixture going in one end and
individual components 'eluting' (it's a good word!) from the other end,
for me to collect and see 'how much'. The computer provided a reading of
the output based on the refractive index of the eluted solution
(eluent), transferring this to an on-screen graph.

As far as I can tell, and feel free to correct me if I'm wrong, diegetic sound refers to anything 'in-story' - so in a film it's sound that comes from the on-screen environment, eg music coming from the radio that a character is listening to is diegetic but the film's score is non-diegetic.

Sometimes a film uses what TV Tropes calls the "Left the background music on" trope in which what seems to be film score or external source music (non-diegetic) for a film suddenly switches to being in the film (diegetic). This is, as I understand it, a diegetic switch. An example is the start of Shawshank Redemption where the music starts off as being external to the film, and then at about 50s into this clip, internal - as in coming from Andy's car radio.

I've no idea how they achieved this - perhaps it's beautifully edited from two playings of the same song, one through a gramophone and the other through a radio speaker. Perhaps they just manipulated the graphics equaliser to make them sound different - if you know tell me :)

Next up is a scene from Woody Allen's film Bananas in which he is invited to have dinner with the President, an offer which almost overwhelms him and his imagination. As he lies back on his bed in reverie the dreamy harp music that plays over the scene, at 28 seconds, is not as it seems...

In the Shawshank example it's the same song that is rendered slightly differently as the diegetic switch happens but in Bananas the music doesn't change but our understanding of it does. In the next two examples something slightly different takes place. As in Shawshank the music in both these clips does change but the switch seems to have more of an emotional resonance than the one in Shawshank (that's not a criticism of it!). First up is a clip from the West Wing, episode Noel, in which Josh is being taken to hospital by Donna after having a bit of a breakdown and injuring himself.

The segment begins around 1m 40 as Donna shepherds Josh out of the West Wing whereupon he hears a choir in the street outside singing and performing the Carol of the Bells on voice and handbells. At 2m 46 the switch shows him zoning out briefly - accompanied by the music taking on a richer sound with additional instruments - before Donna's "Josh!" at 3 minutes in brings both him and the now diegetic-again music back to 'normal'. At the end of the clip the music is again 'augmented', and it's gorgeous, though it doesn't have the same emotional punch as the segment in which Josh is briefly caught up in himself. I think there might be a tiny diegetic switch at 1m 57 too when the music starts being audible but we're still in the White House with Leo McGarry, though presumably the music wouldn't be audible for him.

Another example is from the 1996 film Emma in which the protagonist is enjoying a dance but distressed that her friend isn't, having been snubbed by someone she'd liked to have danced with - the main scene starts at 27s in to the clip. In the background you can hear what sounds like a small group of musicians playing the dance piece as the story unfolds. Then the hero of the hour, Mr Knightley, steps up and invites Emma's friend to join him on the dancefloor and at 2m 15s the music swells and is presumably being played by a much larger group of musicians. Again I'm not quite sure how they managed to switch from one to the other and keep the pitch and timing so perfect. I'd love to see it performed live as a 'live to picture' event (where the score is performed live while the film is screened).

The use of the diegetic switch in both the West Wing and Emma clips seems to be doing something else in addition to just switching the locus of the music, certainly changing the way the audience might feel about the story and its protagonists.